The School of Medicine at University of Missouri-Columbia will implement and study rural telemedicine services in partnership with three small rural Missouri communities. Much of the local health care system in each town will be interconnected using computer networks. Existing telemedicine systems in each community, based on digital video conferencing, will be integrated into the larger network. In addition to creating links between the health professionals within each community, the project will connect rural providers in the other -participating towns, to the University's Health Sciences Center (with its four hospitals, major medical library, hundreds of specialists, and other resources), and to the National Information Infrastructure. Many of the project's telemedicine services will be delivered through the World Wide Web. Studies will involve the tracking of telemedicine utilization, assessment of rural providers' telemedicine and information needs, the impact of telemedicine on the perceptions of rural providers and patients regarding the healthcare available in their communities, the impact of telemedicine services on communications and decision making among rural providers, changes in health-care utilization patterns, and models for analysis of the costs and savings produced by telemedicine.